Fecal and urinary incontinence evaluation and repair
When one suffers damage to the nerves in the sphincter muscles or their nervous system, then fecal and urinary incontinence generally results. Before doctors begin treatments, they need to know why the incontinence is occurring. An evaluation for incontinence can be done in many ways including:
A Physical Exam: The muscles are evaluated physically by checking the inside of one’s rectum using gloved hands or tools.
Colonoscopy: A tube that transmits images is inserted inside the patient to give the doctor a better idea of what is causing the problem.
Proctosigmoidoscopy: A tube is inserted in only the last portion of the colon to check for any problems that may be causing the incontinence such as scarring.
Proctography: An X-ray is conducted while one makes a bowel movement in a prepared environment. This gives doctors a way to measure the amount of stool that is being produced and expelled.
After the problem has been determined, the correct methods will be carried out accordingly. Apart from medication, there are multiple surgical techniques that may be used to rectify fecal and urinary incontinence.
Sphincteroplasty: In sphincteroplasty, the sphincter muscles are retightened by sewing them together in an appropriate manner. This method is often used for women who suffer incontinence after giving birth.
Sphincter replacement or repair: If the sphincter has been highly damaged then it can be replaced with an artificial device. The device remains inflated inside the body and keeps the anal canal closed. In order to defecate, individuals use a pump to deflate the device and in turn allow their stool to pass.
For sphincter repair, doctors use muscles from another part of the body and wrap them around the sphincter to restore the sphincter strength and give patients control again.
Pelvic Prolapse Repair
Pelvic prolapse occurs when the muscles of the pelvic region fail to support the pelvic organs because of overstretching of the tissue, or because the tissue is torn. These organs are forced to prolapse into the vagina. Pelvic prolapse repair can be done either surgically or transvaginally, using minimally invasive methods. There are three major types of pelvic prolapse repair:
Cystocele Repair: Cystocele repair is carried out when the bladder prolapses into the vagina due to a weakening of the muscles or the tissue being torn. The doctor will have to repair the tissue and the wall between the vagina and the bladder. This can be done through the vagina, or if the case is very complicated, it may require surgery.
Rectocele Repair: Rectocele repair is carried out when the rectum prolapses into the vagina because the muscles have been weakened. This often occurs after childbirth and it is fixed by repairing the tissue and wall between the vagina and the rectum. This procedure can be done through the vagina in a minimally invasive way or it may require surgery.
Apical Repair: Apical repair is the most complex of the three pelvic prolapse repairs, and it is required when the top of the vagina prolapses. To repair this, your doctor will fixate the apical portion of the vagina onto two ligaments in your lower pelvic region. Sacrocolpopexy is generally used to treat this form of prolapse. Sacrocolpopexy can be done laparoscopically and robotically as well. When Apical repair is done robotically, the surgeon has a much clearer view of what they are doing, and they are able to perform a more efficient and accurate procedure.
In all three procedures, the doctor will surgically sew together the loose or torn tissue. In many cases, doctors will also use mesh to give your pelvic organs further support.
Sacral colpopexy or sacrocolpopexy is a technique used to rectify vaginal prolapse. Sacral colpopexy can be done in a minimally invasive manner, or it can be conducted as an open surgery as well.
During this procedure, a graft (either a person’s own fascia, or synthetic mesh) is used to support the vaginal wall.
Once the patient is laying in the correct position a prophylactic antibiotic is generally given. After that, an incision is made near the pubic bone and the procedure of inserting the graft takes place using medical instruments that are inserted through the vagina. After the procedure, vaginal prolapse will no longer occur.
Suburethral Sling Revision
Suburethral sling revision is a technique used to aid those individuals suffering from genuine stress incontinence (GSI) and intrinsic sphincter deficiency (ISD). Patients who suffer from GSI and ISD are not able to hold their urine in due to the weakening of their pelvic and sphincter muscles.
If you require treatment for GSI or ISD, a surgeon will first put you under anesthesia and place a Foley catheter in you to drain your urine. The surgeon will then make a small incision in your lower abdomen. During the suburethral sling revision procedure, your doctor will insert a sling (which is approximately 1cm long and made of polypropylene mesh) underneath the urethra to increase compression and prevent the loss of urine.
This procedure generally only takes 15 minutes and the sling does not have to be sewn in, as it will adjust itself within the tissue. After the sling is in, a cystoscope will be used so that the surgeon can see where the sling has been placed. Finally, an antibiotic will be administered to prevent infection of the polypropylene mesh.
Uterosacral colpopexy (also known as uterosacral ligament suspension) can be a laparoscopic or transvaginal procedure used to correct vaginal prolapse. Vaginal prolapse can occur in women where the pelvic muscles and uterosacral ligaments are weakened as a result of childbirth.
The weakening of the pelvic muscles causes one’s bladder to slip down into the vagina. In some cases, women can even see their uterus or cervix protruding from the vagina.
During the uterosacral colpopexy procedure, the uterosacral ligaments are raised and brought together (or plicated) by placing sutures. These stitches are able to uplift the vaginal cuff and rectify the damage or stretching that has occurred. When the procedure is completed, the vagina is elevated back into its appropriate position and the chances of a prolapse occurring again are decreased.